HomeMy WebLinkAboutMOUNTAIN AIR ESTATES #1 BLK 7 LT 3'm
Mountain Air
Estates #1
Block 7
Lot 3
#017-171-10
Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page ( of
ON-SITE WASTEWATER INSPECTION REPORT
st-Jo1az5s,3
Permit Number: o2CaCL?nyX � PID Number: 0 ( —10
Dwelling: FSingle Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New Lpgrade
Nam
�(U't (2,t kk1GVN
ABSORPTION FIELD
Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
❑ Other
Phone
Number of Bedrooms
3
Soil Rating
q
Total depth from original grade
0. GPD/SF
l . E) Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
3. D Ft.
Gravel depth beneath pipe
7e O Ft.
Subdivision Block Lot
Fill added above original grade
Gravel length
t "U"Aa",AV' 3
Township
Range Section
( — Z Ft.
49 Ft.
Gravel width
Z, D Ft.
Beds: Number of Lines
Distance between lines
FL
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
�c
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
�+ %''f Fiz
Ft.
Well
/.!
///�
50f �
TANK antic ❑ S.T.E.P. [3 Holding El Other
1/+'
Manu cturer/ / I� Capacity
K
P✓1 7�4M � 0 oC7 Gal.
SurfaceWater
f Up +
fOd t
Material
�I �•
Number of compartments
Z,
Lot Line
2(7t
((��.�
NA
a
Foundation
f tl t,(.
Z tl,
LIFT STATION
Manufacturer
Capacit
Gal.
Curtain Drain
(.(
%t
1
Remarks_cq�j
Pump on level at
Pump o el at
High water alarm at
M 1M S fLfIr f,
in
in.
in.
Pump maks and model
Electrical Inspections performed by
Installer
PIPE MATERIAL Housetotank �[ Tank to
$03 ! drainfeld 3a3y
•� I /�
Drainfleld 3079-( COrMT3O3
Inspector Mt n P
BENCHMARK (Assumed elevation) ft"L-/ %ZR
f4 �
Inspection t,r 9 r 3 2"" % �/� 3 3 • G'
dates: f
Location and description
3" 4'" (irB O/rn
Czar
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
Conditional Approval: Date011
�`oaaap\
�`p��•OF Ad�SI
:49TH
�
.. ............f
MICHAEL N. ANDERSON .
tilA'�
/
Approved //Z<. �s^ Date (o"2G
CE/ -94 9
�1��Fo i[z�3•°' �`°��
\\� RCFfSS19ti4`�^
inspection Reporr y-t-tr.dl
Pezmit No. SW030283 Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744
On—Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: LOT 3, BLK 7, MOUNTAIN AIR ESTATES #1 S/D PID No.: 017-171-10
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STEEL TANK
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♦�°.MICHAEL N. ANDERSON+=u i
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No. E 469
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MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
U3— 3 c YN/)
1,7eV'N1
Date Issued: Aug 01, 2003
_.._Expiration Date: Jul 31, 2004
Permit Number: SW030283 Parcel ID: 017-171-10
Legal Description:MOUNTAIN AIR ESTATES #1 BLK 7 LT 3
Design Engineer: 0088 Anderson Construction & Eng'g Site Address: 015251 SNOWFLAKE DR
Owner Name: BRUCE & ALICE WILLIAMS Lot Size: 36404 SQ. FT.
Owner Address: 15251 SNOWFLAKE DR Total Bedrooms: 3 Permit Bedrooms: 3
ANCHORAGE. AK 995164435
This permit is for the construction of:
❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy
All construction must be in accordance with:
1. The attached approved design.
❑ Private Well ❑ Water Storage
2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907)343-7904(24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWERMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
ZD
Parcel I.D. 017 — / 7 % — / Permit Number SW0302ey
�/h / 1
Property owners) �k e L 1 Ce /, t (1 a W S Day phone 07 sss 2 /2
Mailing address 0 ✓a 4dAteHVXg6E A
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.)
Legal description(Section, Township & Range)
Lot Size 74( Colo
36,404 Arz�
THIS APPLICATION IS FOR:
FI
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Number of Bedrooms
Well Only
Water Storage
❑ Jacuzzi
❑ Water Softening Unit
w
Fcs 4
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees:
Waiver Fees:
Date of Payment: I Z XT /Q 'L. Date of Payment:
Receipt Number: d 7- q C) Receipt Number:
(Rev. 12100)
Michael N. Anderson, P.E.
Civil/Structural Engineering
4640 Shoshoni Avenue
Anchorage, Alaska 99516
Phone 345-3377
Fax 345-1391
August 1, 2003
Municipality of Anchorage
Department of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Re: Lot 3 Blk 7 Mountain Air Estates, Addition # 1 Subd.
To Whom it may concern:
This is a request for a new septic permit for the above residence. The current system has failed and is
only working somewhat. The asbuilt drawings show a single trench however during the test hole
excavation it was discovered that a seepage pit was installed not a trench. The new 3 bedroom septic
system will fit between the two well radius' and the old seepage pit, see the plan. A separation distance
of 12 feet is all can be achieved therefore a curved system will be necessary to maintain the 14 foot
separation. The perc was 3 minutes per inch with no water table and a bottom of the hole at 18 feet.
The new system is 40 feet long with 7 feet effective, a slower perc was used to give better longevity for
the system. This new system will not encroach on any of the neighboring systems or affect future
development of their lots due to this upgrade.
If you have any question please call me at 345-3377
Sincerely
Michael N. Anderson, P.E.
DESIGN CRITERIA:
3 BDRM X 150 = 450 GPD
SOILS = 450/0.8 = 563 SO FT REO'D
563/14 = 40' TRENCH
(1) TRENCH
10' DEEP
7' EFFECTIVE
2.0' WIDE
40' LONG
5
y CREE
K R
3
.Ra88`` 1pNE�
OFt
`
1 W %3 Vt 5
U
5 J 3
s
W
EXIST G WEYL
EXISTING
NEW SEPTIC
N`
GP
�P
N0WFL,AK
I
i
EXISTING LUFF
WELL
RABBIT CREEK
Septic Design Prepared For
BRUCE WILLIAMS
LOT 3, BLOCK 7
MOUNTAIN AIR ESTATES, ADDITION #1
Prepared By
MICHAEL N. ANDERSON, P.E.
4640 SIIOSHONI DRIVE
(907) 345-3377 / FAX (907) 345-1391
SCALE: 1"=200' AUGUST 1, 2003
OVER
BRIC
OF• A[gs�,ll
:490—
see •,9
it qqi►+ jf.�►
go • MICHAEL N. ANDERSON
.V• CEE9 69
— S N O W F L A K E D R I V E—
��� NEW 1,000 GALLON TANK
REPLACING EXISTING
EXISTING SEPTIC SYSTEM C.O., T?HgAL
` 10'URI TTY
EASEMENT
.0. — ----'
01
�Q•�`�� ��'�ISTING DRIVE WAY
C.O.
T, TYPICAL
.' .E5 STING SEPTIC SYSTEM7 TANK C.O. \� I
30' TEST HOLE—""'
OLE
RADIUS — TYP `
57.1 �
OF BLUFF
2579
o 10
257
Septic Design Prepared For
BRUCE WILLIAMS
LOT 3, BLOCK 7
MOUNTAIN AIR ESTATES, ADDITION 01
Prepared By
MICHAEL N. ANDERSON, P.E.
4640 SHOSHONI DRIVE
(907) 345-3377 / FAX (907) 345-1391
SCALE: 1"=30' AUGUST 1, 2003
I
I
1
I
I
I
I
EXISTING WELL RADIUS
OF� A(.gk%91r1
,0,'- MICHAEL N. ANDERSON
/ Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: Na TG LV I t%^,A S DATE
L
LEGAL DESCRIPTION: LO+ bJf• 7• Mda^� � J''�: Township, Range, Section:
DEPTH i= A, tv%+f tE SLOPE
(FEET) (� ftr„It ti
1
2
3
4
P] P]
10
WASGROUNOWATER _ f O
ENCOUNTERED? /�
it
IF YES. AT WHAT i
.DEPTH?
12
Depth to Wets tiler 7 Z fl tJ2
13 Monitoring? t40Date
14-
15-
16-
17-
18-
4151617
6.44, e!- 4vke"
19-
20-
COMMENTS
s20COMMENTS Gib 4 t.t S4 r t
SITE
Reading Date Gross
Time
.Net
Time
Depth sed—get
Water
7/2 02, fr e.
W e�
/ F
mlu(
PERCOLATION RATE 57 (mmutes/mth) PERC HOLE DIAMETER -
t
TEST RUN BETWEEN 3� FT AND �FT
_ , L Al .4- r ._.. ,.G. /,.0 As G.t ( "I• 5 0..191
PERFORMED BY: M% v' A b e I1\1 Ax 1 ! t S 0 /i I CERTIFY THAT T IS3 EST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE:
72-008 (Rev. 4185)
Municipality of Anchorage
Development Services Department
'f , T I
o +1 Building Safety Division
On -Site Water and Wastewater Program °
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.enchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET
To: MICHAEL N. ANDERSON
Legal description: MOUNTAIN AIR ESTATES #1 BLOCK 7 LOT 3
The attached paperwork has been reviewed and Is being returned for the following reasons:
❑ Original signature or stamp missing on
❑ Calculation error in design. _
❑ Additional soils information needed. _
❑ Water monitoring results inadequate.
® Discrepancy in information submitted. WHERE DID THE CRIB ON YOUR SITE PLAN COME
FROM??
® Topographic information missing or inadequate. MISSING
® Incomplete; missing DRIVEWAY AND CARPORT
❑ Incomplete; missing _
❑ Additional adequacy test information needed.
❑ Water sample unacceptable. _
® Measured/proposed distances/dimensions missing. MISSING
❑ Locations of all soils, percolation and water monitoring tests not shown.
❑ Proposed system too deep for soils information submitted.
❑ Well log required. —
❑ Omission in narrative.
❑ Insufficient fill over tank or field._
® Other. 1) IF 4 BEDROOMS ARE REQUESTED THEN AN UPGRADE SITE IS NEEDED,
2.) THE ATTACHED AS -BUILT SURVEY DOES NOT MATCH YOUR SITE PLAN AT ALL...
Name of reviewer: DAN Date: 12/16/02
Please supply the necessary information and re -submit your request.
LEAVE THIS FORM ATTACHED TO THE PAPERWORK
MUNICIPALITY OF ANCHORAGE
Hey h and Environmental Protc ion
Fourth Floor West
825 L Street
Anchorage, Alaska 99501.
279--25.1-1, x 224, 225
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME-m'd MAILING ADDRESS
- ------- ([,(,'.At ).SCRIPIION
St,PTICUNK..
1F�TANCE, NUMBER OF -21
F�ROM MILL
INSIDE INSIDI WIDTH L()UID DIPTII
LIQUID CAPACITY--.,--. ALLON'
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELL.._____FOUNDATION _NLARUSI LOI LINE --OF LINE
# of Lines DisrANCE HE TWELN LINEi ____TRE.NCH WIDTH_ __ IN. TOTAL EFFECTIVE
A RSORP T 1) N AREA..�? �)_�
s (�. I I-. I, E r,46 r vi o I: E A C I I LINT
DEPIH01 I 11 -1 -IR
J)EPI lir IPP OF FILE. TO FINI(Al GHADL MATERIAL BENEATH TILE, 110. ABOVE I I t -E IN,
SEEPAG�' PIT:
DIAMETER OR WIDTH_.___.,LENGTH_—_, DEPTH
L69 Crib __Rings_ Crib Size: DIAMETER,_,___DEP1 H__ DISTANCE FROM: WELL
'TOTAL LFFECTIVE
eUILDING FOUNDATION—_. NEAREST LOT LINE /\['SORPTI,ON AREA (WALL AREA) FT.
.lass: Depth:
Voll Distance To: Lot Line _ I f i I I 1
ildq t' Sewer Line: X -- -----
t6
?ipe 'Materials: 4
of �Bedrooms: I
Installer:. + � � _ __ _ _ . _ _...
lemarks:
I'l
APPROVI.-D
t
j...JrA 'l C--.- 1 F="Fl!L_ 1 -V'-r" N: _J P'
F-0 r-4 IC'. 1-1 N::) F1 Ci lE
em -
DEPARTMENT HEALTH
AND ENVIRONMENTAL..
oTECTI ON91L
8STREET,
25
ANCHORAGE,
AK. 99.-A-11
L)L6 -
279-2511
r_4.E�; IL FEE
"-E=_ t4 EF;;':
E
F::'F_:F;?lr-1 DE
PERMIT NO.
PPLACANT PlIL-TON MIJLI-.OTT. SRFi BOX 1582 `49:'_",:3.'70
0f_`.ATIf.'_'lN LOT SIZE 38000 SQUARE FEET
EGAI.- L-3 87 MT FIRES EST. SUBD
YPE: OF ', OOIL. ABSORBTION SYSTEM IS: TRENCH
AXIMUM NUMBER OF BEDROOMS = 21. SOIL RATING (SO FT/BRI= 100
Hf.'-'.' REQUIRED
SIZE OF
THE SOIL ABSORPTION
SYSTEM IS:
THE LENGTH I)IMENSICIN IS THE I-ENGTH (IN FEET) OF THE
'THE DEPTH OF A TRENCH OR PIT 15 THE DISTANCE BETWEEN
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
"n CC7 UTnTW FOR TRENCHES
f--mFEF�F" V1.
TRENCH OR DRAINFIELD.
THE SURFACE OF THE
r1r.
1 . rr. C. A .-.I
THE i"3*R.AVEL. DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL. PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
9:-:117-1 N:, --N t.3 F::`0 p I_ r-3 rA.S.....
E:--" ff: W..' FEE E_.ff
- F=* F4 (1- C3 f-= F=0 L_ rt r a r Cl I=:' _F I IL -A t`4
4 PACKAGE PLANT MAY E0i...' INSTALLED AT THE PERMITTEE'*S OPTION SUBJECT TO THE
CONDI-TION 7:
1. EITHER A CLASS I OR 11 NSF APPROVED PLANT MAY BE INSTALLED.
2. A C061TINUOUS MAINTENANCE AGREEMENT IS REQUIRED. IF A MAINTENANCE'
AGREEMENT 15 NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE f'HE S011...
ABSORPTION SYSTEM ANEl/OR' YOU MAY BE SUBJECT TO PROSECL17,1CIN.
— — ----- — — ----- — — — — — — — — — — — --- — I . . .....
14 C" `-2" --a-r I ci F.! FEE FR EF f7! I. -A I FeFE, ED,
t=m FF
3ACKF I I L.. I N(:i t IF' ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL- BY THIS
)EPARTMENT WILA.. BE SUBJECT TO PROSECUTION.
1l'NIllL.lr,1 DISTANCE BETWEEN A WELA.. AND ANY ON-SITE SEWAGE DISPOSAL.. SYS"'I'EM IS
1.00 FEET FOR A PRIVATE WELL_ OR 200 FEET FOR A PUBLIC WEL.1...
3THER REQUIREMENTS MAY API--.,L.Y. SPECIFICATIONS AND CONSTRUf".,.TICIN DIAGRAMS ARE
�VAILABL.E TO INSURE PROPER INSTALLATION.
F
z- I E:lr-lF=.oE: " 7 -:*l :I._ 0 _*_ 7
I F "F -=!EE; t --)'EE*(--:
I CERTIFY THAT
I f-iN f-AMIk IAF: WITH THE REQUIREMENTS FOR ON-SITE SEWERS
BY THE MUNICIPALITY OF ANCHORAGE.
I WILL INSTALL_ THE SYSTEM IN ACCORDANCE WITH THE CODES.
I -SITE SEWER SYSTEM MAY REQUIRE
I i INC)ERSTAN[) THAT THE f -
N
RESIDENCE REMODEL..E.H) TO INCLUDE MORE THAN BEDROOM.'-.,.
S I GNED: .... . .. t_ 941...
L.Tl
I CAN I
I sst..IET) BY
AND WELLS AS
ENL.ARGEMENT IF THE
V'.' 0
SOILS LOG
MUNICIPALITY OF ANCHORAGE
li/ • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION El PERCOLATION
Pouch 6650, Anchorage, Alaska 99602 276.2221 TEST
\� SOILS LOG - PERCOLATION TEST
PERFORMED FOR: M11 -1,0N DATE PERFORMED: 27-1-77
LEGAL DESCRIPTION: el 03-rxreS W tq 0�
DEPTH y SLOPE SITE PLAN
E
E
9
X19
11
12
13
14
15
16
17
18
19
20
COMMENTS
-- _
i
4
GROUND WATER S j
)UNTERED7 GJ L i
PI
ES, AT WHAT E
H7
lading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
)LATION RATE
TEST RUN BETWEEN
FT AND
(minutes/inch)
— FT
PERFORMED BY: G411 -Y ,T %T/t/_ G77 CERTIFIED BY:�a--i DATE: �-`^77
U ✓
72-008 (7/76)
ENKINS WELL DRILLING
P.O. BOX 3-142 ECB
ANCHORAGE, AK 99501
PHONE 344-392
DRILLERS WELL LOG
/U'G zi
lc-�lll�'
CUSTOMER Oe%
LOCATION Le%
SIZE l DEPTH CASING DEPTH 2—ZrV GROUTING DEPTH
YIELD A"-Zo ,r STATIC WATER LEVEL 2�/—'F HOW TESTED
PUMP INSTALLED
TYPE
FORMATIONS ENCOUNTERED AND APPROPRIATE DEPTHS
TO��
TO �o
TO a
TO
% TO /Z),Sr
TO
TO
TO
TO
TO
TO
TO
iUNICIPHLITY OF ANC -`.-AGE �
�
DEPHRTNENT OF HE�LTH AND ENYIRONMENTAL PROTECTI J
U�'
825 'L' STREET/ ANCHORAGE, Al"', 99501
t-l"',
��� ~�
PERMIT NO. ( 770995 ) �~~-�� "
APPLICANT MILTON MELLOTT N=770996 '
LOCHTION SNOWFLAKE DRIVE
LEGAL L] B7 MT HIR EST#1
VIT SIZE 36404 SQUARE FEE
MINIMUM DISTANCE BETWEEN A WELL HND ANY ON�SI
100 FEET FOR H PRIVATE. WELL OR 200 FEET FOR H
WELL LOGS ARE REQUIRED AND MUST BE
OF THE WELL COMPLETION.
RETURN~
OTHBR REQUIREMENTS MAY APPLY. SPECIFICHTILl
HVHILHBLE TO INSURE PROPER INSTALLATION.
I CERTIFY THAI"
1� I HM FHMILIHR WITH THE f,_.-T.*QUIREME
FORTH BY THE MUNICIPALITY OF ANCHOR
ISSLED BY
TON MIELLDT|l
`
WHGE DISPOSAL SYSTEM IS
�BLIC WELL
THE DEPARTMENT WITHIN ]0 DHYS
CONSTRUCTION DIAGRAMS FIRE
WITH THE CODES.
�
MUNICIPALITY OF ANCHORAGE
• '� DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D.# C)N \ -1L) HAA# QC)n9.QC)gn1
1. GENERAL INFORMATION
Complete legal description LQT 3 BLOCK 7 MOuwTAiw AIR EST ADD. -1
Location (site address or directions) 15251 5imo (FLAKE DR.
Mt
Property owner
Day phone _271-21G2-
Mailing
71-21G2.
Mailing address 15271 5MOWFLAKE DR.
Lending agency CITY MORICAGE Day phone ZTT-OZ77
Mailing address (21 W. I -I pEwEED LANE
Agent N are Day phone %1n
Address 121 W. FIREWEED LA13E LEMDER)
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
3
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
—
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA 921
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation. of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm 5k1LH ons t -fn-n-s Phone 3.45-L947
Address P O. Box 11022 A-nchnra.q A1< i 51 i
Engineer's signature Date 11-3 d -3Z
6. DHHS SIGNATURE
_ Approved for -ZZU_-e .' bedrooms.
Disapproved.
Conditional approval for
Additional Comments
0
UITIC
0FA
3 491h "s
91� HanelBa
Q a - 7604
l
9�®,' PROFESS10�
bedrooms, with the following stipulations:
Date ��
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA 021
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: LnT 3 5LOCK7 MOIJUMN hR *1 Parcel I.D. (// � — / 1/ /0
A. WELL DATA
Well type PVT If A, B, or C, attach ADEC letter. ADEC water system number NA
Log present (Y/N) i (ATTACHED) Date completed I S DEG. 1978 Driller
TEMKiWS
WcLLDrw
Total depth 105' Cased to
loot Casing height
20 �
Sanitary seal (Y/N)
Wires properly protected (Y/N)
Y
z
;;KJ
c_
C; 7
FROM WELL LOG
AT INSPECTION
P TT
>
� T
Date of test 18 DEC 78
12 Nov. 92.
?'
cn O
ni -n
Static water level 20
Well flow 15.20
g.p.m.
g.p.mF w
Pump level No% PECORDF_D
umywowN
SEPARATION DISTANCES FROM WELL TO:
2
O
Septic/holding tank on lot 1 1% To TAWk
GLITAuouT ; On adjacent lots EA2
2181
(P5TIMATa)
To MUN1TOR TUBE
Absorption field on lot 112' TO F410 ITOR
MRC; On adjacent lots 120'
t-iQUITOR
TU9C (C'ALLU--
LATEM
Public sewer main NONE
Public sewer manhole/cleanout
NGNE
Sewer service line
Petroleum tank NONE VI5l5LC
WATER SAMPLE RESULTS: I
Coliform Nitrate NOI,Y ? bLTFC'iED Other bacteria
Date of sample: ll-Iz 9'L AKSQ 11-23-92 Collected by: 5. kC_tQSL.FE
B. SEPTIC/HOLDING TANK DATAL'J� � ��;;��
L'✓ 01
Date installed S" 8 - 77 Tank size 0 100-Ca/�L. Compartments �—
Cleanouts (Y/N) i (One unLY) Foundation cleanout (Y/N) N Depression (Y/N) N
High water alarm (Y/N) NA Alarm tested (Y/N) K.A_
Date of pumping 10/1 S_192_ Pumper ZSAAG5 iii IMPI NL SERV Ic
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
r
Well(s) on lot I ICoi O o On adjacent lots f(UZ Foundation 21
To property line 16 FROM TAIvrAbsorption field Water main/service line JNI<NOtnlN
C,0 -
Surface water/drainage MOTH IN VISI3LE
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
SEPARATION DICE FROM LIFT STATION TO:
lot
D. ABSORPTION FIELD DATA
On adjacent lots
"Psixup 6ff" level at
tested
— Surface water _
Date installed 8 - 8 - 77 0 Soil rating 1001 System type TRCNc++ 1
Length 231 1 Width 3611 (D Gravel thickness 74 (D' Total depth 9� MEASURED
1
Total absorption area 3ZZ Cleanouts present (Y/N) Y
Depression over field (Y/N) N Date of adequacy test
Results (pass/fail) PASS for 3 bedrooms
Peroxide treatment (Past 12 months) (Y/N)
If yes, give date N A
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
120' (CALCU I.ATED) 1
Well on lot 112 ro WELL C SIN On adjacent lots "r""" Property line 10�
To building foundation 21 FROM TANK c QTo existing or abandoned system on lot NOOE;
On adjacent lots 112 Cutbank 75
1
Water main/service line NA
Surface water WQNfE 1At it LES Driveway, parking/vehicle storage area 10' E,"1"IM/-\TED
Curtain drain NA
E. ENGINEER'S CERTIFICATION
1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
•••
Signature\ ^;
jjjk/ sNpM N+Aoeei
Engineer's 2-621 -9 Name %TE UE/�/ ��,�i(%SLG� •�• w
/ L °A steven C.1{9neIBB.eaeb�
Date °b
CE - 9604 �" a
PRESOAKCD 5Y5T_E" FOP, 4&iAWR.,. T_mmoDocE}7 Q1 ��17
HAA Fee $ / 76, Dd
Date of Payment / 7-- 61- g -7-
Receipt
Receipt Number 4 V 273 1/� 4-1% �D
Waiver Fee: $
Date of Payment
Receipt Number
SKLH Consultants
P.O. Box i 10c'C l
Anchorage., AK 99511
( 907) 345--6947
A D E 0 U A C Y T E.S T REPO RT
LOCATION: 3/1 MT AIf2 ESrApp *1 JOB NUMBER:
INSPECTOR: SA DATE: (Z moo )?—
TYPE OF DWELLING; S, Fc-mi1u SEPTIC TANK SIZE: 100p O,
NO. OF BEDROOMS: 3 j
TYPE OF S. A.S. - Tre-A&
CALCULATE PEAK LOAD: CrjQ v X �0
oLt r. Vi ,. a.a leu Fir
�
r �'�
TEST RESULTS:
REVIEWED BY:
DO -1 E: /Z - Z15,-
-uummENTS
;Liquid
LevelI
•
r r
oLt r. Vi ,. a.a leu Fir
�
r �'�
TEST RESULTS:
REVIEWED BY:
DO -1 E: /Z - Z15,-
6�r C3 ,
V�rvp
VoX.
Ldyau
\O�T�GoN�
50' y
VJ
„/
;A
QO,Uo St e.0 1.M MR1taT,
S E31Y
a
" x: -BUILT'
I hereby certify that I have surveyed the following described property: LOT 3 'BUD C..
V, [:'. <�'` / j (:;I and that no encroachments exist except as indicated.
Exclusion Note: �-WMA\'t
It is the responsibility of the owner to determine the existence of any easements, ��� At ' N
covenants, or restrictions which do not appear on the recorded subdivision plat. AvfK •' '•.;r1
Under no circumstances should any data hereon be used for construction or for TH
establishing boundary or fence lines. So 10 49--
Rated at Anchorage, Alaska, this J - day of
ASBUILT
�s
RALPH B. JOKELA
L5 - 3081 C3
,`1,1islol►a\ �i�
d
a
Z
Z
QO,Uo St e.0 1.M MR1taT,
S E31Y
a
" x: -BUILT'
I hereby certify that I have surveyed the following described property: LOT 3 'BUD C..
V, [:'. <�'` / j (:;I and that no encroachments exist except as indicated.
Exclusion Note: �-WMA\'t
It is the responsibility of the owner to determine the existence of any easements, ��� At ' N
covenants, or restrictions which do not appear on the recorded subdivision plat. AvfK •' '•.;r1
Under no circumstances should any data hereon be used for construction or for TH
establishing boundary or fence lines. So 10 49--
Rated at Anchorage, Alaska, this J - day of
ASBUILT
�s
RALPH B. JOKELA
L5 - 3081 C3
,`1,1islol►a\ �i�